Lumbar Discitis; prevalence and management after lumbar disc surgery

ABSTRACT

To study the occurrence of discitis after lumber disc surgery and its management. Observational study. Department of Neurosurgery QAMC/ BVH Bahawalpur. April 2006 to May 2009. This study includes 400 patients who underwent standard laminectomy procedure for disc excision. Patients presenting with backache and leg pain were thoroughly investigated. For the confirmation of herniated disc MRI or lumber route myelography were performed. All patients underwent either fenestration, hemilaminectomy or complete laminectomy for disc excision. Patients were followed for two weeks to three years after surgery. The diagnosis of discitis was on clinical grounds but this condition was confirmed by heamatological examination i.e. ESR, complete blood count, C-reactive protein and radiological examination i.e. MRI, CT and plain X-rays. Eighteen [4.5%] patients out of four hundred patients developed dicitis after surgery. Initially all patients were managed conservatively i-e. with complete bed rest and antibiotics .Fifteen [83.33%] patients responded well to this treatment but three [16.67%] patients did not improve and were subjected to surgery. Discitis after lumber disc surgery is rare. Discitis should be considered in any patient who develops severe backacheleg pain and muscles spasms after one to four weeks of lumber disc surgery especially accompanied with fever, raised ESR and elevated C-reactive proteins. A definitive diagnosis is essential for appropriate therapy of discitis